Surprise/Balance Billing Notice
"Surprise/Balance billing" is when you receive treatment by a health care facility or provider that is not in your health plan's network, referred to as "out-of-network." A balance is the difference between what your health plan agreed to pay and the full amount charged for the service you received.
Your Rights and Protections Against Surprise/Balance Billing
If you get emergency services from an out-of-network provider of facility, the most the provider or facility may bill you is your plan's in-network cost-sharing amount (such as copayments and coinsurance). This includes services you may get after you are in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
In-Network Hospital Or Facility
If you receive certain services related to your emergency services such as, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or internist services at an in-network hospital or facility, the most out-of-network providers may bill you is your plan's in-network cost-sharing amount. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get non-emergency services at in-network facilities by out-of-network providers, the providers cannot balance bill you, unless you give written consent and give up your protections. You have the right to request that in-network providers perform all covered medical services. However, you may have to receive medical services from an out-of-network provider if an in-network provider is not available.
You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan's network.
If you believe you have been wrongly billed, you may contact our Patient Financial Services Department at (775) 445-7550